There is substantial evidence that physicians do not have adequate training in palliative care. In preliminary work, we have developed evaluation methods and curricula for physicians and established a hospice rotation for 65 residents training in three programs of internal medicine and two programs in family medicine each year. We hypothesize that a hospice rotation using a national curriculum for palliative care education for physicians will result in measurable improvements in knowledge, attitudes and skills. The primary endpoint for study is the scores on a validated 36-item question of knowledge for which a national reference database exists. Secondary endpoints are self-rated scores of confidence and competence in palliative care. We will test this hypothesis applying the same curriculum to 65 resident three from five different training programs each year for five years. Programs will administer the evaluation instruments to their residents within the first month of the PGY-1 year. Residents will be required to complete four modules of the EPEC Curriculum, a national curriculum covering the core competencies of palliative care for physicians using the internet for self-study. Faculty will help the student apply the attitudes, knowledge and skills during clinical exposure to patients in the inpatient and home hospice settings. Residents will demonstrate communication skills with a standardized patient. The instruments will be readministered during the last two months of residency training. Psychometrically equivalent knowledge examinations will be used to prevent recall of items on repeated examination. We will analyze the data using the One-Group Time Series Design. The package of three evaluation instruments will be administered at four time periods during the three years of residency training- Pre 1 (beginning of residency); Pre 2 (beginning of rotation); Post 1 (completion of rotation); Post 2 (completion of residency). The One Group Time Series Design permits us to evaluate questions that are on the minds of all residency program directors as they seek to incorporate a palliative care curriculum within the three-year training period: 1) What effect does the curriculum have if it is required versus elective? 2) How long does the rotation need to be? In other words, what is the effect of time on task? 3) When should the rotation be placed in a 3-year residency, in the beginning or the end? 4) Are there differences between internal medicine and family practice residents who are exposed to this curriculum? 5) Does the type of training program (university hospital versus community teaching hospital versus military hospital) have any effect on the retention of information? and 6) Is there evidence of yearly interaction among these various factors? [unreadable] [unreadable] [unreadable] [unreadable]